Surgical treatment of displaced olecranon fractures in children.

Thirty-five children who had fractures of the olecranon were reviewed. Age at the time of injury ranged from 0 years 2 months to 15 years 4 months. Fractures were retrospectively classified as type I or II according to the amount of displacement apparent on the initial radiographs. Type I fractures were those with < 3 mm of displacement, and type II were those with displacement of > or = 3 mm. Type I fractures (n = 23) were treated with closed methods, and splint or cast immobilization was maintained for an average of 3 weeks. All 23 type I fractures had satisfactory results on follow-up. Type II fractures (n = 12) were treated with open reduction and internal fixation. Greater intraarticular displacement was often seen intraoperatively than had been appreciated radiographically. Ten of 12 patients with type II fractures were available for follow-up; all had satisfactory results. Restoration of the articular surface in children with olecranon fractures optimizes joint function and growth potential. The amount of fracture may be more than is apparent on plain radiographs.

A 13-year-old boy with rapidly progressive spinal deformity.

The following case is presented to illustrate the roentgenographic and clinical findings of a condition of interest to the orthopedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on the first page. The final clinical and roentgenographic differential diagnoses are presented on the following pages.

Distal humeral osteotomy for correction of posttraumatic cubitus varus.

Twelve patients with posttraumatic cubitus varus were treated by a laterally based closing wedge osteotomy of the distal humerus. Smooth crossed K-wires held the osteotomy. After a minimum follow-up of 2 years, a good or excellent result was obtained in 83% of patients as assessed by clinical and radiographic examination. All patients and families were satisfied with their cosmetic outcome. Correction of even severe cubitus varus deformities is obtained with this straightforward surgical technique. The overall complication and morbidity rate is acceptably low, which is important in a procedure performed primarily for cosmetic indications.

Cloning of the gene encoding the major outer membrane protein of Haemophilus influenzae type b.

The major outer membrane protein (P2) of Haemophilus influenzae type b (Hib) with an apparent molecular weight of 37,000 to 40,000 has been previously shown to function as a porin and also as a target for antibodies protective against experimental Hib disease. The gene encoding the Hib P2 protein was cloned by using a shuttle vector capable of replication in both Escherichia coli and H. influenzae. The amino acid sequence of the amino terminus of the Hib P2 protein was determined and used to design an oligonucleotide probe corresponding to the first 20 amino acids of this protein. This oligonucleotide probe was used to identify Hib chromosomal DNA fragments containing the Hib P2 gene. These DNA fragments were ligated into the plasmid vector pGJB103 and then used to transform a rec-1 mutant of H. influenzae Rd. Recombinant clones expressing the Hib P2 protein were identified in a colony blot-radioimmunoassay by using a monoclonal antibody specific for a surface epitope of the Hib P2 protein. The gene encoding this Hib protein was present on a 10-kilobase Hib DNA insert in the recombinant plasmid. Transformation experiments involving the recombinant plasmid suggested that unregulated synthesis of Hib P2 is a lethal event in E. coli. The recombinant Hib P2 protein was exposed on the surface of the recombinant H. influenzae strain. This recombinant strain was used to develop a system for detecting polyclonal serum antibodies directed against surface determinants of the Hib P2 protein. The availability of the gene encoding the Hib P2 protein should facilitate investigation of both the immunogenicity and the structure-function relationship(s) of this major outer membrane protein.